Dose-Dense MVAC With Pegfilgrastim Support in Subjects With Muscle-Invasive Urothelial Carcinoma

Tracking Information
First Submitted Date ICMJE	December 15, 2008
First Posted Date ICMJE	December 16, 2008
Results First Submitted Date	January 14, 2014
Results First Posted Date	May 15, 2014
Last Update Posted Date	October 24, 2016
Study Start Date ICMJE	December 2008
Actual Primary Completion Date	December 2013 (Final data collection date for primary outcome measure)
Current Primary Outcome Measures ICMJE; (submitted: April 15, 2014)	Number of Patients Achieving Pathologic Response [ Time Frame: After completion of 4 cycles of chemotherapy with pegfilgrastim support (cycle length 2 weeks) ]; Pathological response is defined as down-staging to </=pT1, N0 after chemotherapy with pegfilgrastim support.
Original Primary Outcome Measures ICMJE; (submitted: December 15, 2008)	To estimate the pathologic response of this patient population treated with neoadjuvant chemotherapy and pegfilgrastim followed by radical surgery with curative intent. [ Time Frame: 3 years ]
Change History	Complete list of historical versions of study NCT00808639 on ClinicalTrials.gov Archive Site
Current Secondary Outcome Measures ICMJE; (submitted: April 15, 2014)	Number of Patients Experiencing Febrile Neutropenia [ Time Frame: After completion of 4 cycles of chemotherapy with pegfilgrastim support (cycle length 2 weeks) ]Febrile neutropenia defined per CTCAEv3 as Grade 3 or higher and treatment attribution possibly, probably or definitely-related.; Number of Patients Experiencing Surgery-related Toxicity [ Time Frame: Surgery + 30 days ]Surgery-related toxicity defined per CTCAEv3 as Grade 2 or higher and treatment attribution possibly, probably or definitely-related.
Original Secondary Outcome Measures ICMJE; (submitted: December 15, 2008)	To document the rate of febrile neutropenia and compare to historical standard for MVAC [ Time Frame: 3 years ]; To document perioperative morbidity and mortality in this cohort. [ Time Frame: 3 years ]
Current Other Outcome Measures ICMJE	Not Provided
Original Other Outcome Measures ICMJE	Not Provided
Descriptive Information
Brief Title ICMJE	Dose-Dense MVAC With Pegfilgrastim Support in Subjects With Muscle-Invasive Urothelial Carcinoma
Official Title ICMJE	A Phase II Trial of Neoadjuvant Dose-Dense MVAC With Pegfilgrastim Support in Subjects With Muscle-Invasive Urothelial Carcinoma
Brief Summary	The purpose of this research study is to test the effectiveness of neoadjuvant dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin (ddMVAC) in combination with pegfilgrastim followed by radical surgery in patients with muscle-invasive urothelial carcinoma.
Detailed Description	Participants will be given a study infusion schedule for each treatment cycle. Each treatment cycle lasts three weeks. The infusion of methotrexate will take place on the first day of each cycle. Infusions of vinblastine, doxorubicin and cisplatin will take place on the second day and an injection of pegfilgrastim will be given on the third day.; During all treatment cycles participants will have a physical exam and will be asked questions about their general health and any problems they might be having and any medications they may be taking.; Following completion of study treatment, but before surgery, participants will have an assessment of their tumor by CT scan of the chest and and MRI of the abdomen and pelvis.; Following the participants surgery, we would like to keep track of their medical condition indefinitely, or until this study is officially completed. We would like to do this by calling the participants on the telephone once a year to see how they are doing.
Study Type ICMJE	Interventional
Study Phase	Phase 2
Study Design ICMJE	Intervention Model: Single Group Assignment; Masking: None (Open Label); Primary Purpose: Treatment
Condition ICMJE	Bladder Cancer; Muscle-invasive Bladder Cancer
Intervention ICMJE	Drug: Methotrexate intravenously 30mg/m2 over 30 minutes; Drug: Doxorubicin intravenously 30mg/ms over 15 minutes; Drug: vinblastine intravenously 3mg/m2 over 30 minutes; Drug: cisplatin intravenously 70mg/m2 in 1 liter NS with 12.5gm Mannitol over 2 hours after vinblastine completion; Drug: Pegfilgrastim Given subcutaneously 24 hours after last chemotherapy dose
Study Arms	Experimental: Dose Dense MVAC; Chemo therapy with methotrexate, vinblastine, Adriamycin, Cisplatin; Interventions: Drug: Methotrexate; Drug: Doxorubicin; Drug: vinblastine; Drug: cisplatin; Drug: Pegfilgrastim
Publications *	Choueiri TK, Jacobus S, Bellmunt J, Qu A, Appleman LJ, Tretter C, Bubley GJ, Stack EC, Signoretti S, Walsh M, Steele G, Hirsch M, Sweeney CJ, Taplin ME, Kibel AS, Krajewski KM, Kantoff PW, Ross RW, Rosenberg JE. Neoadjuvant dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin with pegfilgrastim support in muscle-invasive urothelial cancer: pathologic, radiologic, and biomarker correlates. J Clin Oncol. 2014 Jun 20;32(18):1889-94. doi: 10.1200/JCO.2013.52.4785. Epub 2014 May 12.
* Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
Recruitment Information
Recruitment Status ICMJE	Completed
Actual Enrollment ICMJE; (submitted: December 15, 2008)	39
Original Estimated Enrollment ICMJE	Same as current
Actual Study Completion Date	September 2016
Actual Primary Completion Date	December 2013 (Final data collection date for primary outcome measure)
Eligibility Criteria ICMJE	Inclusion Criteria: Histologic proof of urothelial cancer. Patients with all histologic subtypes are eligible as long as transitional cell carcinoma is predominant, with the exception of more than a few clusters of small cell carcinoma, which is treated with different chemotherapy and thus are ineligible; Patients with primary tumors arising in the bladder or urethra are eligible if they have clinical T2-T4a disease; Patients with primary tumors arising in the ureter or renal pelvis are eligible if they have either grade 3 tumors, or radiographic abnormality large enough to be recognized as an abnormal mass by CT/imaging; Evaluation by a urologist and be deemed to be acceptable surgical candidates within 3 months of registration; Adequate physiologic reserves as outlined in the protocol; Clinical or pathologic N1 lymph node involvement (involvement of a single lymph node < 2cm in greatest dimension) are eligible. Patients with N2-3 or M1 disease are ineligible; Determination of LV function with an EF > 50%; Women of child-bearing potential must have a negative pregnancy test; Patients of child-bearing or father-bearing potential must agree to use an acceptable form of birth control while on the study; Patients with prior malignancy are eligible provided that the expected outcome from the prior cancer is such that this will not interfere in the delivery of this therapy, or the assessment of response in the cystectomy specimen; 18 years of age or older Exclusion Criteria: Current, recent (within 3 weeks), or planned participation with other experimental anti-cancer medications as part of clinical trials; Prior treatment with doxorubicin; Prior systemic cytoreductive chemotherapy for bladder cancer; Blood pressure of > 160/100 mmHg. Patients whose blood pressure can be controlled with oral medication are eligible; NYHA Grade II or greater congestive heart failure; History of myocardial infarction or unstable angina within 6 months prior to study enrollment; History of stroke or transient ischemic attack within 6 months prior to study enrollment; Clinically significant peripheral vascular disease; Evidence of bleeding diathesis or coagulopathy; Known history of central nervous system or brain metastases; Major surgical procedure, significant traumatic injury within 21 days prior to Day 1, or anticipation of need for major surgical procedure during the course of the study; Lactating women; Patients who are not candidates for surgery, or unwilling to undergo surgery; Patients with significant fluid collection; Known hypersensitivity to any component of cisplatin, methotrexate, vinblastine, doxorubicin or pegfilgrastim
Sex/Gender	Sexes Eligible for Study: All
Ages	18 Years and older (Adult, Older Adult)
Accepts Healthy Volunteers	No
Contacts ICMJE	Contact information is only displayed when the study is recruiting subjects
Listed Location Countries ICMJE	United States
Removed Location Countries
Administrative Information
NCT Number ICMJE	NCT00808639
Other Study ID Numbers ICMJE	08-208
Has Data Monitoring Committee	Yes
U.S. FDA-regulated Product	Not Provided
IPD Sharing Statement	Plan to Share IPD: No
Responsible Party	Toni Choueiri, MD, Dana-Farber Cancer Institute
Study Sponsor ICMJE	Dana-Farber Cancer Institute
Collaborators ICMJE	Beth Israel Deaconess Medical Center; Brigham and Women's Hospital; Amgen
Investigators ICMJE	Principal Investigator: Toni Choueiri, MD Dana-Farber Cancer Institute
PRS Account	Dana-Farber Cancer Institute
Verification Date	September 2016
ICMJE Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP